Physicians Pharmacy Alliance is an Equal Opportunity Employer

Personal Information
*First Name:
Middle Initial:
*Last Name:
*Address:

*City:
*State:
*Zip Code:
Preferred Name:
*Primary Phone:
Secondary Phone:
*Email Address:
Work Information
*Position you are applying for:     If "Other", please specify:  
*Daily Availability
  Monday
Hours:  
  Tuesday
Hours:  
  Wednesday
Hours:  
  Thursday
Hours:  
  Friday
Hours:  
  Weekends
Hours:  
Available to Work Overtime:
Do you have any relatives currently employed with Physicians Pharmacy Alliance:

If yes, please provide their name:
Have you ever worked for Physicians Pharmacy Alliance before:

If yes, please provide the following:
Previous Position:  
Previous Supervisor:  
Reason for Leaving:  
*How did you hear about this job?
If you heard about this job from an employee,
please provide their name:

Are you legally authorized to work in the United States?
Are you at least 18 years old?
If no, please provide your age:
This company participates in E-Verify. Pursuant to the Immigration Reform and Control Act of 1986, all applicants upon being made an offer of employment, must produce documents which are specified by the federal government, establishing their identity and authorization for employment in the United States. These documents must be produced no later than 72 hours after commencement of employment. You also will be required to sign form I-9, issued by the federal government, verifying, under oath, your employment authorization.
Employment History

Please list your most recent position first. Account for all periods of time, including military service. Please do not state "see resume." Complete the entire application, even if your resume is attached.
Please account for any gaps in employment history:
May we contact your current employer?
Have you ever been discharged or asked to resign from any employment?
If yes, please explain:
Education History
High School
*Name:   *City, State:  
*Graduation Status
If you did not graduate, please explain:
College History

Most recent college first.
Please list any additional ceritifications, education or other qualifications you posess:
References

Please list professional references only. No relatives.
*Reference 1
Name:
Company:
Phone Number:
*Reference 2
Name:
Company:
Phone Number:
*Reference 3
Name:
Company:
Phone Number:
Other Information
Have you ever been convicted of a crime?
If yes, please explain:
A criminal conviction is not an absolute bar to employment, however, any person on the OIG Exclusion list is not eligible for hire. Since Physicians Pharmacy Alliance will consider the nature of the crime, when it occurred, any subsequent rehabilitation you may have undergone and the specific requirements of the job for which you have applied, please describe:
Resume
Please be sure to include a copy of your current resume.
Cover Letter and/or Text Resume
Attach Resume:
EEOC Compliance

Physicians Pharmacy Alliance is dedicated to equal opportunity in employment, without regard to race, religion, gender, sexual orientation, national origin, age, veteran, disabled status, or any other protected class. Reasonable accommodation will be made as appropriate to enable any employee or applicant for emplyment to safely and properly perform the job applied for as requested and as appropriate.
The following information is necessary for this company to evaluate its hiring practices and to track its progress and effectiveness in complying with its equal employment policies. The information is voluntary and will be kept confidential insofar as possible. Information provided will not be considered in any part of the selection process.
Sex:
  Male
  Female
  Do not wish to provide at this time.
Ethinicity: Select all that apply.
  Hispanic or Latino
  American Indian or Alaska Native
  Black or African American
  Asian
  White
  Native Hawaiian or Other Pacific Islander
  Do not wish to provide at this time.
Veteran Status:
  Vietnam Era Veteran
  Disabled Veteran
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview could result in my release. This application does not constitute a contract of employment and any employment with Physicians Pharmacy Alliance is at-will.
Check here to certify: